Healthcare Provider Details

I. General information

NPI: 1457325730
Provider Name (Legal Business Name): GERSHON Y PERRY M.D., F.A.C.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 05/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

979 E 3RD ST SUITE A 350
CHATTANOOGA TN
37403-2136
US

IV. Provider business mailing address

PO BOX 21731
CHATTANOOGA TN
37424
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-7156
  • Fax: 423-634-8050
Mailing address:
  • Phone: 423-778-7156
  • Fax: 423-634-8050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD026032
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: